The case has been made for the role of the addictive process in the obesity epidemic. Does it explain the entire epidemic? No. The problem is much too complicated for that. However, for tens, even hundreds of years, people have been describing an addiction to certain foods or overeating in general. See the poem by Rumi, The Worm’s Waking.
More recently, science has objectively substantiated what has been described subjectively for years. Most notably, the work of Nora Volkow (now the head of the National Institute on Drug Abuse) and Gene-Jack Wang (at the Brookhaven National Laboratory) began identifying the common brain pathways between overeating and other substances and behaviors more traditionally considered addictive.
This was further demonstrated for me, personally, the other day when I found our 1 year old Shih Tzu dog, Popcorn, on top of our kitchen table. What was odd about the scene was that we had him for a year before he ever had the nerve to climb up there. However, given my personal and professional understanding of the brain reward mechanisms involved with ingesting high fat/sugar/calorie “foods,” combined with the fact that we had just finished celebrating my son’s birthday with ice cream cake, Popcorn’s behavior was perfectly predictable, if not entirely rational.
And what of doggie obedience class? That got me thinking, too. It’s been great fun attending the classes and teaching Popcorn to sit, stay, walk and come. But how do I get him to do that? Do I use celery? Chicken? An apple? Almonds? No. I am told by the trainer to bring “treats.” So, like I do with all my packages of human food, I turn the bag over and, low and behold, there it is. The first ingredient is the same one as in nearly all 100 calorie packs: wheat flour.
Next, I reference the online glycemic index as one indicator of rise in blood sugar levels for various foods. It turns out that wheat flour has a higher glycemic index than table sugar. This brings me back to the work of Volkow, Wang and others. Thanks to their elegant work, we know that the brain rewards high calorie, high fat, high sugar food. So, I guess the moral to this story is that if you want your dog to sit, feed him some treats, but you had better keep the treats off the kitchen table.
Seriously, the problem is that what happens when the behavior becomes automatic for our dogs is the exact same process that occurs for us. After the puppy’s brain connects the word “sit” with the brain reward, all we have to do is say the word and the dog sits.
My worry is that this is why so many of my patients describe a loss of control with their eating. For some people, repeated ingestion of “foods” that “light up” the brain’s reward centers lead to the same automatic behavior as that in other animals. This begins to explain why some people describe fast-food restaurants as being like giant magnets attracting their cars. Or why suddenly while watching TV at 9 pm, they find themselves in their kitchens with the food already in their stomach before they had a chance to “think.”
Having identified and described the so-called addictive process as part of the larger problem of obesity, I did promise in my last blog to begin the discussion of contemporary approaches to address this problem of loss of control over food. I will fulfill this promise in a future blog. Meanwhile, for some thoughtful ideas on the topic, see the reader responses to my last blog.